Behavioral Science - Bipolar Disorder - Thomas L. Schwartz

Question 1

Increased self esteem/grandiosity;
Decreased sleep;
Increased speech;
Racing thoughts;
Distractibility;
Increased activity (energy);
Increased dangerous impulsivity

These are symptoms of:

Answer 1

Mania
Must have 3 persisting for at least 7 days
Must cause distress or dysfunction
Cannot be due to another disorder

Question 2

What does DTRHIGH stand for?

Answer 2

Distractible
Talkative
Racing Thoughts
Hyperactive
Impulsive
Grandiose
Hyposomnic

Mania symptoms

Question 3

How is hypomania different from full blown mania?

Answer 3

Milder;
At least 4 days or more
Same symptoms as mania
Symptoms provide a chage in personality, noticeable by others
Not severe enough to cause marked impairment

Question 4

Can you have both mania and depression at the same time?

Answer 4

Yes, called a “mixed episode”

Question 5

What is rapid cycling?

Answer 5

4 or more episodes per year

bipolar disorder

Question 6

T/F: 10% of bipolar disorder sufferers have only mania and no depression.

Answer 6

True

Question 7

Cyclothymia is composed of:

Answer 7

hypomania (2+ years) and periods of minor depression
Suicidality increased in these patients bc the blow of the depression is a severe difference from their previous feelings

Question 8

How long must a period of depression persist to meet the criteria for dysthymia?

Answer 8

2+ years

Question 9

The average patient spends ____ months in a euthymic state.

Answer 9

6

Question 10

What is the Kindling Hypothesis?

Answer 10

Too much neuronal limbic firing

Low receptor, high chemical

Question 11

What is the prevalence of bipolar 1 among men and women?

Answer 11

1%, the same in both genders

Question 12

Women have a greater occurrence of what kind of bipolar disorder than men?

Answer 12

Bipolar 2

Question 13

How can stress increase manic symptoms?

Answer 13

Less sleep, disruption of circadian rhythms;
Lower med compliance;
Increase substance abuse

Question 14

How does psychotherapy work for manic episodes of bipolar disorder?

Answer 14

It doesn’t
During maintenance however, it can be helpful

Antimanic agents:
Lithium
Divalproex - increases GABA
Carbamazepine - blocks Na channels and promotes neuronal health;
atypical antipsychotics - all block D2 receptors and increase connectivity (risperidone, aripiprazole, olanzapine, asenapine)

Question 15

A patient has mania and you want to prescribe a treatment. Which property below would you like to manipulate by way of prescribing?
A. Block Na+ channels to slow neuronal firing
B. Stimulate D2 receptors to increase limbic activity
C. Increase NE release robustly into synapse

Answer 15

A. Block Na+ channels to slow neuronal firing

ie Lamotrigine

Question 16

A 40 yo patient has had bipolar 2 disorder for 15 years but comes to your office in a fully mani state that has lasted 14 days. What is the correct diagnosis?

A. Cyclothymia
B. Bipolar 2
C. Bipolar 1

Answer 16

C. Bipolar 1

Question 17

What is the DSM 5 criteria for mania?

Answer 17

distinct, abnormal, elevated, expansive mood that persists for at least 7 days

3 or more characteristic symptoms that persist for at least 2 weeks
(Goal directed hyperactivity must be present)

must cause distress/dysfunction

Cannot be due to another disorder/condition/substance use

Question 18

What are the 7 characteristics of mania?

DR. HIGETH

Answer 18

Distractable 
Racing thoughts
Hyperactivity (goal oriented)
Impulsive
Grandiose
Elevated mood (Euphoria)
Talkative
Hyposomnia

Question 19

How is hypomania different from mania?

Answer 19

milder form of mania
symptoms must persist for at least 4 vs 7 days and cause unequivocal change in function/personality noticeable by others but not severe enough to cause marked impaiment

*must still cause distress/dysfunction and can’t be due to another conidition/drug

Question 20

Criteria for Major Depressive Episode

Answer 20

pervaseives sadness, down, irritable (lasts more than 2 weeks)

Must cause distress/disfunction and can’t be due to something else

Question 21

What is difference between cyclothymia and dysthymia?

Answer 21

opposites - low level mania vs low level depression for 2+ years

euthymia = normal mood in psychobable

hyperthymia is similar but less severe to cyclothymia

Question 22

What is a mixed episode?

Answer 22

Meets criteria for both Mania and Major depressive episode